PLEASE SELECT ONE:Initial Application: New applicant- not currently credentialed through Fairview.Additional Facility: Currently credentialed within Fairview and would like to add another Fairview location.Additional Privilege: Currently holds privileges at Fairview and would like to add new privileges.

CONTACT INFORMATIONApplicant's Direct E-mail Address:
YOUR APPLICATION and REAPPOINTMENTS WILL
BE SENT TO THIS EMAIL.

Information Used for Password Setup:

Applicant's Month/Day/ Year of birth:
Applicant's Social Security number:

A direct e-mail address is required and will be used for credentialing purposes and for other Fairview/HealthEast purposes if a legitimate need has been identified with the understanding that it is not to be used for publication or distribution to other organizations or individuals. The credentialing process may require email communications about confidential information. Applicant should provide an appropriate email address to maintain their confidentiality.

For medical staff membership at the listed hospitals for Physicians, Dentists, and Oral and Maxillofacial Surgeons, who desire to be associated with the facility but do not wish to exercise clinical privileges.
See the applicable Fairview Hospital Medical Staff Bylaws for additional information.